LVAD ACADEMY

Advanced Heart Failure Center

Piedmont Hospital, Atlanta GA

(Drive Line

exit site)

2

Normal Heart Heart Failure Heart Failure Normal Heart

Mild

(Class I) No symptoms

Mild

(Class II) Slight symptoms that

slightly limit physical

activity. Comfortable

at rest or with mild

activity

Moderate

(Class III) Many physical activities

are limited. Only

comfortable at rest

Severe or Advanced

(Class IV) Any/all physical activity is

limited. Not comfortable at

rest or lying down

Possible treatment option: optimal medical management by a

heart failure specialist, pacemaker &/or defibrillator

Possible treatment option: intravenous medications, VAD

&/or Heart Transplant, Palliative care.

HEART FAILURE

A surgically implanted, rotary continuous-flow device Percutaneous driveline (exit site) Electrically powered

DC power (batteries) AC power (wall)

Fixed speed operating mode

What is a LVAD?

Exit Site 3

WHAT IS A HMII LVAD?

Replicate the function of a failing native heart while imposing as few complications as possible.

Bridge the gap between supply and demand of donor hearts.

Serve as a permanent therapy in patients not eligible for transplantation. (“Destination Therapy”, DT)

Serve as a temporary therapy in patients during the decision making process. (“Bridge To Transplant”, BTT)

ALL Ventricular Assist Devices are:

“Preload Driven” & “Afterload

Sensitive”

5

WHO NEEDS A HMII LVAD?

Heart failure affects over 5.3M patients in the

United States.1

300,000-800,000 Americans have advanced

heart failure.2

Over 280,000 patients die of heart failure each

year.1

1 Lloyd-Jones D, Adams R, Carnethon M, et al. American Heart Association

Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke

statistics 2009 update: a report from the American Heart Association Statistics

Committee and Stroke Statistics Subcommittee. Circulation. 2009;119(3):480-6.

2 Adams KF, Zannad F. Clinical definition and epidemiology of advanced heart

failure. Am Heart J 1998;135:S204-S215.

WHO GETS A LVAD & WHEN?

Symptoms

Recurrent admissions

Refractory

At rest

Medications

Intolerance or lower doses

ACE-I/ARBs

Beta blockers

Increasing diuretic doses

Hypotension

Laboratory

Renal insufficiency

Hepatic dysfunction

Hyponatremia

Pulmonary Hypertension

RV dysfunction

Unresponsiveness to CRT (Cardiac Resynchronization Therapy)

Inotropes Unable to carry out

ADLs

HM II SYSTEM COMPONENTS:

INTERNAL/IMPLANTED

Implanted Components: • Inflow Conduit

(attaches to LV)

• Motor Outflow Conduit (attached to aorta)

• Driveline with Velour tunneled in Abdominal Cavity

8

HM II SYSTEM COMPONENTS

Implanted Components:

Implantable titanium blood pump & drive line

External Components:

System Controller

Power Module

Power Sources Power Module

Batteries & Clips

Accessories

9

HEARTMATE 3 SYSTEM COMPONENTS*

System

Controller *New for HeartMate 3

Modular

Cable

WHERE IS A LVAD?: ANATOMICAL

PLACEMENT

11

LVAD EQUIPMENT

Batteries

System

Controller

Battery with

Battery Clip

Battery

Charger

Mobile

Power

Unit

SYSTEM CONTROLLER

HM II HM III

13

HM II SYSTEM CONTROLLER USER

INTERFACE

14

HM III SYSTEM CONTROLLER USER

INTERFACE

15

Pump Running

Symbol

Display Button

Battery Button

Silence Alarm Button

User Interface

Screen

Status Symbols

Cable Disconnect

Symbols

HEARTMATE II POCKET SYSTEM

CONTROLLER •Safety by Design

•Backup battery

•Prioritized visual alarms with

clear, actionable instructions

•Driveline diagnostic capability

•Programmed for use in 37

languages

•Designed for an active lifestyle

•Lightweight and compact with

single-side cable design

•Durable, shock-resistant outer

case, cables, and electronics

•Intuitive, discreet, and comfortable

interface

16

HEARTMATE II SYSTEM CONTROLLER

• Delivers power to the pump

• Controls and monitors system operation

• Identifies alarm conditions and initiates

Hazard and Advisory Alarms

• User Interface displays the following

available in 37 languages:

• Pump parameters (Flow, Speed,

Power, PI) and status of Backup

Battery charge

• Visual alarms with clear, actionable

instructions

• Accessible alarm history of last six

non-transient alarms

• Display Module no longer required

• Backup battery housed within the

controller

• Driveline diagnostic capability

• Records alarm data and device

performance (240 events)

17

SYSTEM CONTROLLER USER INTERFACE :

BATTERY BUTTON

Battery Button Functions 1. Operating battery fuel gauge

2. Starting a System Controller self test

3. Putting a running System Controller into

Sleep Mode

18

Battery

Button

SYSTEM CONTROLLER BATTERY GAUGE –

RUNNING ON BATTERIES

19

SYSTEM CONTROLLER USER INTERFACE:

ALARM BUTTON

Alarm Button Functions 1. Silencing active alarms

2. Displays last six relevant alarms

when pressed simultaneously with

the Display button

Alarm Button

USER INTERFACE: SILENCE ALARM

BUTTON

Alarm Button Functions 1. Silencing active alarms

2. Displays last six relevant alarms

when pressed simultaneously with

the Display button

3. Symbol below will appear on LCD if

audio alarm is silenced

21

Silence Alarm Button

*

*New for HM III

SYSTEM CONTROLLER USER INTERFACE:

DISPLAY BUTTON

Display Button Functions:

1. Activates the information display screen

Pump speed

Flow

Pulsitility Index

Power

Backup battery charge

Blank default screen

2. Displays last six non-transient alarms when pressed simultaneously with the Alarm button.

22

Display

Button

VIEWING PUMP AND SYSTEM PARAMETERS: DISPLAY

BUTTON: HM II

23 Will default back to this screen after 15 seconds

Press the

Display

Button to

view pump

parameters

and

backup

battery

charge

status on

the display

screen.

24

*

*New for HM III

Press the

Display

Button to

view pump

parameters

and backup

battery

charge

status on

the display

screen.

Viewing Pump and System Parameters: Display

Button: HM III

VIEWING ALARM HISTORY ON SYSTEM

CONTROLLER

The last 6 alarms can be viewed on the user interface screen Simultaneously press and release the silence alarm and display buttons

To view the next alarm, press and release the display button

Alarms that do not appear on the System Controller alarm history screen

Non transient alarms that require specific action to resolve Driveline Fault

Controller Backup Battery Fault

Controller Fault

Routine events Power Cable Disconnected

advisory alarm which lasts less than

30 seconds

Pulsatility Index (PI) Events 25

VIEWING LAST SIX RELEVANT ALARMS: DISPLAY BUTTON

To view last six non-

transient alarms on

the display screen

1. Press the Display and

the Alarm button at the

same time.

2. Then press the Display

button to scroll through

the alarms.

26

SYSTEM CONTROLLER 11 VOLT LITHIUM-ION

BACKUP BATTERY

• Supplied non sterile

• Must be installed in the controller once the operating sterile field

is broken

• Powers the pump for at least 15 minutes during a power-loss emergency

• Charges while connected to a power source (Power Module with 14V

patient cable OR 14 Volt Li-Ion Batteries)

• The Admin and Settings Screens of the System Monitor show use of the

system controller back-up battery by the patient

• Patients should not replace the 11 volt Lithium-Ion backup battery

• Expiration date: 36 months from manufacture date and/or 24 months shelf

life.

Warning: The 11 Volt Lithium-Ion backup battery should be used only for temporary support

during a power-loss emergency. The 11 Volt Lithium-Ion backup battery inside the HeartMate

II System Controller provides enough power to run the implanted HeartMate II pump for at

least 15 minutes if the main power source (either the Power Module or two HeartMate 14 Volt

Lithium Ion batteries) is disconnected or fails. Inappropriate use of the 11 Volt Lithium Ion

backup battery may result in diminished run time during a power-loss emergency. 27

POWER SAVER MODE

If external power is removed or fails, a fully charged

backup battery in the system controller will provide 15

minutes of full power then enters power saver mode

System Controller slows the pump speed to the low

speed limit to save power

IMPORTANT! System Controller alarms cannot be silenced when the

System Controller is in power saver mode.

28

AC power from Power Module (PM) or Mobile Power Unit (MPU)

DC power from a pair of 14-volt lithium-ion batteries and clips

LVAD SYSTEM COMPONENTS:

EXTERNAL

POWER SOURCES & POWER CHANGES

29

POWER MODULE (PM)

Serves as the electrical interface between the System Controller and the System Monitor or Display Module

20’ patient cable attaches to System Controller power leads (white to white and black to black)

Repeats alarms generated by the System Controller Alarm silence button will only silence the PM alarm for 5 minutes

Supplies power to the LVAD when plugged into: Electrical outlet

Automobile power outlet (e.g., cigarette lighter socket)

Visual and audio alarm indicators provide feedback on PM system operation Perform self-test daily

30

POWER MODULE

Alarm Silence

Button

Internal Battery

Charge Indicator

(Green or Yellow)

Internal Battery

Alarm

(Yellow or Red)

Power On

Indicator

(Green or Yellow)

Yellow Wrench

Advisory & Hazard

Alarm

31

PM INTERNAL BATTERY

Internal battery provides approximately 30 minutes of backup power in the event of power interruption or failure

Remains charged as long as the PM remains connected to AC power or automobile DC power

Will operate the LVAS until the battery is depleted

Takes 1.5 hours to fully recharge when depleted

System Monitor or Display Module will loose power

Prior to use, verify internal battery is installed and charged

Yellow wrench and red battery alarm with continuous tone indicates internal battery is not installed

32

MOBILE POWER UNIT (MPU)

Supplies power to the LVAD when plugged into an Electrical outlet 20’ patient cable

attaches to System Controller power leads (white to white and black to black)

Echoes alarms generated by the System Controller

Alarms powered by 3 Alkaline AA batteries Replaced every 6

months

33

MOBILE POWER UNIT (MPU)

Patient

Cable

Power On

Symbol Yellow Wrench

Alarm

Replace Mobile

Power Unit

Battery Alarm

34

MOBILE POWER UNIT (MPU)

Power On Symbol: illuminated green when the Mobile Power Unit is powered and functioning properly.

Yellow Wrench Alarm: illuminates when the MPU detects a mechanical, electrical, or software issue – switch to 2 fully-charged batteries

Replace MPU Battery Alarm: illuminates when the Alkaline AA batteries are not installed, or are depleted and need replaced.

35

Priori

ty

Active

Symbols

Alarm

Means To Resolve alarm

Ad

vis

ory

Internal

Fault

1. Promptly connect patient to two

fully-charged HeartMate® 14 Volt

Lithium-Ion batteries.

2. Call your hospital contact and

replace the Mobile Power Unit.

Replace

Mobile

Power Unit

Batteries

Replace the internal AA batteries in

the Mobile Power Unit.

MOBILE POWER UNIT ALARMS

The power symbol ( ) is illuminated green when the Mobile

Power Unit is powered and functioning properly.

36

LVAD SYSTEM COMPONENTS: EXTERNAL

POWER SOURCES & POWER CHANGES

14-volt, lithium ion

Approx. 12 hours of support on a

pair of batteries

Drains both batteries

simultaneously

On battery fuel gauge indicates

charge level

Four hours to recharge fully

discharged battery

Service life of 360 cycles or 36

months from the date of

manufacturer, whichever comes first

Dispose of expired batteries

according to local, state, and federal

regulations BATTERIES 37

CLEANING BATTERY & BATTERY CLIP

TERMINALS

Clean battery terminals and interior

contacts of battery clips once a week

with an alcohol moistened swab

Dirty battery terminals may prevent

proper charging in the Universal

Battery Charger

Allow the alcohol to evaporate prior

to use

38

UNIVERSAL BATTERY CHARGER

Performs diagnostic testing and charges up to four HeartMate

batteries in four hours or less

Provides most accurate percent of battery charge level

Monitors use cycles of each battery

Pocket lights indicate battery charge status

Monitors the need for calibration and calibrates individual

HeartMate batteries

Weighs eight pounds

39

CHANGING FROM PM TO BATTERIES

1. Place 2 fully charged batteries into

battery clips by aligning arrows

2. Unscrew white power lead from

PM/PBU cable & connect to battery

clip

Power Cable Disconnected alarm will

sound

3. After alarm resolves, unscrew black

power lead from PM/PBU cable &

connect to battery clip

4. Check battery fuel gauge

5. For SLA batteries, turn Velcro® circles

from white to black

6. Place batteries in GoGear accessory 40

CHANGING FROM BATTERIES TO PM

1a. For PBU, verify PBU plugged into outlet,

turned on & PBU patient cable connected

1b. For PM, verify PM plugged into outlet & PM

patient cable connected

2. Remover batteries & clips from GoGear

accessory

3. Unscrew white power lead from battery clip &

connect to white PM/PBU cable connector

Power cable disconnect advisory will sound

4. After alarm stops, unscrew black power lead

from battery clip & attach to black PM/PBU

cable connector

5. Recharge batteries if necessary

SLA Batteries: verify Velcro circles are black &

place into PBU

14 volt Li-Ion Batteries: place in UBC

41

CONTROLLER COMPATIBLE WEAR AND

CARRY ACCESSORIES

Shower Bag Consolidated Bag

Protection

Bag

Belt

Attachment Lanyard

Battery Holster Holster Vest

(small, medium and

large)

AVAILABLE WITH POCKET CONTROLLER

CURRENTLY AVAILABLE

•Smaller and designed

to be more intuitive,

discreet, and

comfortable

•Accessories kit comes

with each implant kit

and is sold separately.

It contains:

•Belt Attachment

•Lanyard

•Protection Bag

42

SOLD

SEPARATEL

Y

VITAL SIGN MONITORING o Temperature

Blood Pressure Manual Cuff and Doppler are usually

required; patient may have an automated BP, however very unreliable

Use manual cuff, pump to ~120-140mmHg. Slowly deflate cuff. First sound you hear is patients blood pressure…the sound may be a “lub”, a “dub” or a “swish”. It will be a single number. AKA Return to Flow (RTF)

Target RTF=60-80. 90-100, look at patient trend. Is this normal? May need BP medications increased

Pulse oximetry

if obtainable, may be unreliable due to the diminished pulse pressure 43

DEVICE PARAMETERS

Device parameters Speed: how fast the pump is going (rpms)

Call if speed fluctuates (up or down) by >150

Power: how much electricity the pump is using (watts) Call if power doubles or goes up to 10 watts

Flow: how much blood is going through the pump (L/min)

PI: the patient’s own heart function/contractility

Monitoring No single parameter is a surrogate for

monitoring patient’s clinical status NORMALLY: Speed, Power, Flow=change

together & in the opposite direction of PI Note baseline values

Trends Abrupt changes

PUMP

PATIENT

44

PUMP FLOW PRINCIPLES

Pump flow is a function of:

The speed of the rotor

↑Speed → ↑Flow

↓Speed → ↓ Flow

The difference in pressure across the pump

↑ Pressure gradient → ↓ Flow

↓ Pressure gradient → ↑ Flow

45

FLOW ESTIMATOR DESIGN

Flow measurement does not use a sensor or flow probe

Flow range 3 – 10 liters/minute

Derived from motor power and speed providing an estimate of pump flow ↓ Power → ↓ estimated Flow

↑ Power → ↑ estimated Flow

For a given speed, pump flow is linearly related to power (over a limited range)

46

PUMP POWER

Measured in watts

Related to pump speed and flow

Under normal patient conditions, power should remain within a certain range for a specified speed ↑ Speed → ↑ Power ↓ Speed → ↓ Power

Flow ↑ Flow → ↑ Power (takes more work to move more blood) ↓ Flow → ↓ Power (does not compensate for ↑ afterload)

Monitoring

Normal

Increases or decreases with pump flow and speed without abrupt changes

Power fluctuations of 1-2 watts do not necessarily indicate a problem but should be closely monitored

Power values > 10 – 12 Watts requires further investigation Fluctuations related to bearing seating

Some pumps exhibit high power consumption for several days post op and then drop to “normal”

Power will abruptly rise or fall ~2 watt Monitor trends for both ↑ and ↓ in Watts

Is patient symptomatic?

47

PULSATILITY INDEX (PI)

The Pulsatility Index (PI) is a measurement of flow pulse

through the pump

It is determined by pump speed and the degree of native LV

contractility

Pump speed determines the amount of LV unloading

As speed increases the PI goes down

As speed decreases the PI goes up

48

TAKE THE GO-BAG!!!

o Back-Up system Controller

o Two extra batteries

o Two battery clips

o Poncho

o Alarm pamphlets

o Cell phone

Contents:

49

PHYSICAL THERAPY/OCCUPATIONAL THERAPY

Must be out of bed in chair for every meal

Ambulate 3-4 times/day every day

Increase ambulation distance & length of time

out of bed each day

50

OUTPATIENT MANAGEMENT

Most Frequent calls Medical questions or

concerns

Lightheaded, dizzy, dehydration

Most frequent alarms Power cable

disconnected

Low battery advisory

Weekly Clinic Visits (every

Thursday in the Advanced

Heart Failure Center-95

building, 3rd floor)

Weekly INR values (may be

done in home town)

51

NUTRITION& DAILY WEIGHT

maintain adequate volume (2L/day)

Avoid dehydration

Cardiac Diet=low fat, low cholesterol, low sodium

Avoid foods rich in Vitamin K (green leafy vegetables,

cranberry juice)

Avoid herbal supplements

Control blood glucose levels

Daily weights and paying attention to symptoms such as orthostatic hypotension

Call if weight fluctuates 3 – 5 pounds

52

ANTICOAGULANT PROTOCOL

INR ranges Reasons (past medical

history) for being on

Warfarin

1.5-2.5 (if only 1 reason to be

on blood thinner)

2.0-3.0 (if 2 reasons for being

on blood thinner)

2.5-3.5 (if 3 or more reasons for

being on blood thinner)

LVAD,

Mechanical Mitral or Aortic

valve,

Atrial or Ventricular Fibrillation,

DVT/PE,

Stroke

53

THE DRIVE LINE—LEFT SIDE

EXIT SITE ANCHOR=TWO FINGERS

FROM INSERTION SITE!!! The Foley Anchor

2x2 gauze w/ 1 piece of

paper tape directly over

site

The Drive

Line

54

55

DRIVELINE CARE

Weekly Anchor Change (& as needed)

– Use “Foley Anchor” Kit: purchase through WalGreen’s

at Piedmont or through the manufacturer

– 2 finger widths from insertion site

Daily dressing change (& as needed)

– Use clean technique

– Clean with Antiseptic agent such as chlorhexidine or

betadine

– Apply dry, sterile 2x2 dressing

– Secure with 1 piece of paper tape

56

CARE OF THE DRIVE LINE:

Do not severely bend, kink or twist the percutaneous lead

Do not “catch” the percutaneous lead in a zipper

Allow for a gentle curve, do not severely bend the lead multiple times or wrap it tightly

Keep the percutaneous lead clean

Never submerge the lead or system components in water or liquid

Do not pull on or move the lead going through the skin.

Gently tug on metal end of connector, NOT lead, to check connection into system controller

Wear the HeartMate Stabilization Belt or immobilizing device AT ALL TIMES to prevent pulling on or moving the lead.

Be mindful of where the system controller is at all times.

Protect the controller from falling or pulling on the lead.

Don’t allow the percutaneous lead catch or snag on anything that will pull on or move the lead

Check the percutaneous lead daily for cuts, holes, tears

57

WARNINGS, PRECAUTIONS & RESTRICTIONS

No excessive jumping or contact sports

No swimming or bathing

Shower using the Shower Bag (p. 106 of handbook)

No exposure to MRI

Avoid strong static discharge

Touching TV, computer screens

Vacuuming carpets

No pregnancy

No heating pads or electric blankets

Can not sleep on stomach 58

ALARMS HM II

59

ALARMS HM II

60

ALARMS HM III

61

ALARMS HM III

62

REPLACING A SYSTEM CONTROLLER Replace The Running System Controller with The Backup Controller and

MULTIPLE Power sources

1

Set-up

a. Place the back up System Controller within reach.

b. Have the patient sit/lie down as he or she may get dizzy if the pump

briefly sops.

c. Unlock the driveline safety tab on the running System controller.

2

Replace

System

Controller

Multiple Power Sources Available

(have Power Module AND Batteries & Clips)

Important! Keep the running System Controller connected to Power.

a. Connect both the white and black connections on the backup Controller

to power.

b. Promptly, move the driveline from the running controller to the backup

controller.

3

Finish

a. Lock the driveline safety tab on the backup Controller. The safety tab

cannot move to the locked position unless the driveline is fully and

properly inserted. Confirm that the pump running symbol is green,

pump is running.

b. Put the old, replaced Controller into Sleep Mode by disconnecting from

power then pressing and holding the battery button for 5 seconds.

c. Do not use the old System Controller ever again. Contact your hospital

contact or Thoratec Corp to request a new backup System Controller

and for instructions on returning the old one. 100

Replace the Running System Controller With The Backup Controller and a

SINGLE Power Source

1

Set-up

a. Place the back up System Controller with reach.

b. Have the patient sit/lie down (you may feel dizzy if the pump briefly

stops).

c. Unlock the driveline safety tab on the running System Controller.

2

Replace

System

Controller

In-use Power Source Only

(either Power Module OR Batteries & Clips)

a. Move the white connector's power source from the running controller to

the backup System Controller.

b. Promptly move the driveline from the running controller to the backup

System Controller.

c. Move the black connector’s power source from the running controller to

the backup System Controller.

3

Finish

a. Lock the driveline safety tab on the backup System Controller. The

safety tab cannot move to the locked position unless the driveline is

fully and properly inserted. Confirm that the pump running symbol is

green, pump is running.

b. Put the old, replaced System Controller into Sleep Mode by pressing

and holding the battery button for 5 seconds.

c. Do not use the old System Controller ever again. Contact Thoratec Corp

to request a new backup System Controller and for instructions on

returning the old one.

REPLACING A SYSTEM CONTROLLER

64

SYSTEM CONTROLLER DRIVELINE

CONNECTIONS

1. To insert the driveline, slide the safety tab back

to unlock and expose the red button

2. Align the arrow on the controller to the arrow on

the driveline cable until they connect, and firmly

insert the driveline until it snaps into place

3. Be sure to slide the safety tab back over the red

button, locking the driveline in place.

4. Tug gently on the metal portion of the driveline

to ensure it is fully engaged.

65

REPLACING A SYSTEM CONTROLLER WITH

A BACKUP CONTROLLER

If controller does not restart:

Check driveline connection

Check power sources

Push any button

66

EMERGENCY CARE OF THE

HEARTMATE II (LVAD) PATIENT

Emergency Notification Guide Call 911 After calling 911, immediately

call the 24 Hour LVAD Support Line: 404.605.3066.

You should call the support line whether the emergency is LVAD related or not.

67

EMERGENCY CARE OF THE

HEARTMATE II (LVAD) PATIENT

In the event of a

respiratory arrest,

rescue breathing should

be initiated using the

American Heart

Association guidelines.

10 to 12 breaths per

minute

OR

One breath every 5 to 6

seconds

In the event of a cardiac

arrest, CPR should be

initiated using the

American Heart

Association guidelines.

Compressions – Airway

–Ventilation

Compression to

ventilation ratio = 30:2

68

PEARLS OF LVAD CARE:

WHEN TO CALL: 404-605-3066

69

CRITICAL INR: <1.5-3.5>

RTF <60-90>

ANY LVAD ALARM CONDITION

WEIGHT GAIN OF 3-5 LBS IN 24 HOURS

S/S of STROKE (FAST)

S/S of INFECTION (redness, swelling, heat, pain,

purulent drainage at the driveline site, fever,

chills)

PERSISTENT FRANK BLEEDING/

DARK, TARRY STOOLS

Complication Signs & Symptoms

Gastrointestinal Bleeding

(GI Bleed)

Bloody Vomit: looks like coffee grounds

Bloody Bowel Movement: looks like tar

(black, stringy, loose)

Stroke

F—(FACE) unequal smile

A---(ARMS) unable to grasp or lift one

S---(SPEECH) slurred or strange

T---(TIME) move quickly, call 911

Infection

Temperature, obvious source? With white

or green drainage, tender or red

ICD firing/Arrhythmias

Defibrillator will deliver a shock

Driveline Damage Check daily for damage, nick or cuts

70

TIPS The pump flow cannot adjust for patient activity,

therefore, many patients experience dizziness or fainting.

The patient & their caregivers are the LVAD competent individuals!!!

The pump is very sensitive to blood volume. Hypovolemia/Dehydration can cause the pump to malfunction.

HeartMate II patients are anticoagulated with Warfarin.

LVAD patients have ICDs that may discharge during an abnormal heart electrical rhythm. (If external defibrillation/shock is necessary, leave the pump running. Do NOT disconnect the System Controller from the percutaneous lead before delivering the shock)

71

ALWAYS CALL!!!

ADVANCED HEART FAILURE CENTER

Non-Urgent Needs (prescription refills, questions,

appointments, etc.) 404-605-5566

Urgent Needs (Immediate response required) 404-

605-3066

Emergency Needs 911

72